Nomination Form

Please fill in the form below as completely as possible. Fields marked with an asterisk are required.

Nominator Information
Please fill in your contact information below in case we need to contact you regarding this nomination.
Salutation	Mr Mrs Miss Ms Dr
* Your First Name:
* Your Last Name:
Your Organization:    (if applicable)
* Street Address:
Street Address (continued):
* City:
* Province:	Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Postal Code:
Telephone:
* E-mail:

Nominee Information
This is a nomination for …
Salutation	Mr Mrs Miss Ms Dr
* First Name:
* Last Name:
Contact Details:
Work           Home
Organization:    Required if “Work” selected above
* Street address:
Street address (continued):
* City:
* Province:	Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Postal code:
Telephone:
E-mail:

Nomination Summary
Please answer the following questions, limiting your responses to 250 words.
a) When did the project begin and, if relevant, when was it completed?
b) What makes this work innovative? How does it stand out from the crowd? Is this a model that others can apply to similar environmental problems?
c) How effective has it been? What are the tangible environmental benefits? How have these been measured?
d) How has this project affected, influenced and engaged others in the community? How far-reaching are its scope and impact in involving others? How has it changed the actions, attitudes and perceptions of others?
e) How viable and sustainable is this work? Are there plans to expand or enhance this initiative? What steps are being taken to make this happen?
f) What has impressed you about the actions of the nominee? What is he or she doing that others are not?
Other comments: